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Get and Sign Section AI Authorize the Disclosure of My Personal Health Information to the PersonsEntities as Described in Section B below

Get and Sign Section AI Authorize the Disclosure of My Personal Health Information to the PersonsEntities as Described in Section B below

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Be deemed to include information related to sexually transmitted diseases such as HIV or AIDS alcohol or drug use or treatment or mental health/psychology/psychiatry that may be within your above request unless you specifically state your objection here Person/Entity Authorized to Disclose I authorize the person s and/or entity ies described below to disclose the personal health information described above All providers with medical records relevant to my request for external review Providers....
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